Dynamic Integration - When Too Much Integration is not Enough!

Clark Kegley, MBA CHCIO

Scripps Health, San Diego CA

Asst. Vice President, Information Services

December 1, 2015

• I will not make anyone in this room a better CIO.

• I will help you understand what CIO stands for.

• I will not change your work life by telling you things

today you don’t already know.

– You already get the mission.

• I hope to make you think and, perhaps, make you

laugh a little.

My Purpose Today

A Happy Thanksgiving!

Harley

Jasmine

“The Princess”

Overview of Scripps Health

– 91 year old organization

– Five acute care hospitals

– Twenty Nine community based clinics

• Scripps Clinic

• Scripps Coastal Medical Centers

• Mercy Clinic

– Home Health Agency

– Hospice

– Seven Medical Groups

– Four Well Being Centers

Overview of Scripps Health

– Three Urgent Cares

– 40% of the Trauma System in San Diego

– Four Emergency Departments

– Several Medical Office Buildings

– Approximately $2.5 billion in revenues

– Approximately 14,000 employees

• One of San Diego’s largest employers

– Approximately 2,600 affiliated physicians

– Over 1,300 hospital beds

Overview of Scripps Health (cont.)

Overview of Scripps Health

– U S News & World Report Best Hospital Systems

– Fortune Magazine’s 100 Best Companies To Work For

• 8 on the Top 10 Best Companies for Female Employees

• 8 on the Top 10 Best Paying Companies

– Best Places To Work for Workers Over 50

– Best Places To Work for Women

– Best Places To Work for Diversity

– Dr. Eric Topol – 50 Most Influential Physician Leaders

– Top 10 Non-profit for Executive Women

– Chris Van Gorder recognized as one of the most influential people in healthcare

Scripps Health Accolades

The ACA – In the beginning…

Impact on Healthcare IT - Drink Up!

Everyone is Talking About Healthcare Transformation, Innovation, and Disruption……

But We Have Done This Before……

We’ve Done It With Hardware…… 1.0

Mainframes

Tomorrow is here…

We’ve Done It With Integration…

Healthcare Integration 1.0

Let’s Ask Why???

– FACT: Healthcare is the only industry on the planet that uses interface engines the way that we do.

– Data Analytics:

• Crimson

• Cognos

• Blah, Blah, Blah…

Healthcare Integration 2.0

The Basics Still Apply… Challenge

Don’t Put Technology or Innovation at the Top of the

Three Legged Stool….

It’s Coming!

Star Wars Reboot

Apple’s Roadmap May Include Construction

We Live In Troubled Times, Personal Protection Is Top Of Mind For Many….

The Point Is That Innovation & Technology Can Get Silly If Not Aligned With The Strategic & Operational Goals Of The

Business.

Healthcare Realities…

– On a good day, Healthcare is about 15 – 20 years behind ever other industry in terms of technology & innovation.

– Technology will not make a physician/clinician better, but it could make them faster and it should make them safer.

– Healthcare is the most heavily regulated industry on the planet.

– Our industry is quickly moving from a physician-centric model to a patient-centric one.

Start Here To Support Clinical & Business Operations IT Shops Must….

– Be at the table! Alignment starts there.

– Understand what clinical or business problem is being solved.

– Approach solutions as a business/clinical process analyst.

– Sometimes, technology is not the answer. Don’t forget about people and process.

And Here To Support Clinical & Business Operations IT Shops Must….

– Be willing to admit you don’t know, but you better find out.

• “I’m from Kentucky. You have to speak slowly and use small words.”

– It’s OK to disagree, just don’t be disagreeable!

– Strike “Works as designed!” & “What are the requirements?” from your vocabulary.

– Everything’s my/ITs fault. Now let’s move on!

Decision Making Process

• “Shiny Thing Syndrome” – Dr. Prominent attends a conference and sees a system they simply cannot live without.

• Problem Definition is King!

– If you can’t write it down on a napkin or a white board you probably don’t fully understand the whole process.

– What happens when you automate a bad process?

• You get an automated bad process that allows you to make mistakes faster than before!

– Too often organizations fail to evaluate their existing processes for improvement, train their people on the improved process THEN evaluate streamlining the revised process with technology.

The “Right Way”

Start With Process & People…

– Consider the Following:

• Adopt LEAN into your organization. I meant the IT one!

– At Scripps = Value By Design

– Don’t Forget the Frontline Folks!

– Go To The Gemba!

• Adopt the parts of ITIL/ITSM that work for your team.

• Train your people on them. – A3’s, workshops, other

– IS Academy

– Get comfy, this will take a while

• Hold people accountable to the new way of doing things.

– Build it into their compensation

How To Do It The Right Way

Mercy San Diego Emergency Department Redesign

• Goal: How do we reduce the time it takes to navigate

through the ED at Mercy?

– Wait times were too long

– Patient satisfaction suffered as a result

– Sick people were camped out in the waiting room or in

beds/hallways waiting to be seen

The Solution

• Approach: Everyone connected to this problem was locked in a room for many days to craft a solution.

– Do we agree on the actual problem?

• If yes, why do we think it is occurring?

• Can we write down on paper our entire, current process from the moment patients present?

– Once fully documented, what areas of opportunity exist for improvement?

– What training must be done with staff to fully implement the improvements?

– The Results – wait times were dramatically reduced in the ED such that Scripps has advertised wait times of 30 minutes or less in a downtown San Diego trauma center!

The Solution

Oh yeah, the team did not use a single piece of

technology to achieve their results.

The Right Way

• IT shops should be enablers of the business

– We need to understand the problem in order to

recommend any technology solution.

– Evaluate & modify/enhance the existing process.

– Train your people on the enhancements.

– Track your progress on improvements.

– Then evaluate whether technology will add further

improvements.

Become Process Redesign Experts

• Principles To Help The Business Evaluate Their Problem

And Then Craft A Solution

– As a technology enabler my job it to take all the emotion out of the discussion.

– Let’s not connect dots that don’t belong together.

– We can disagree without being disagreeable.

– Let’s be candid about how much of our current technology we use today and commit to not repeating the same mistakes.

• Some studies show that Healthcare uses between 18 & 29% of the available functionality of any given technology system.

• Can you imagine buying a new car, removing 3 wheels and then entering a road race?!?

– All participants should agree on the approach for solving the business problem.

– Act, then check, act, then check again, act and keep checking.

• If you screw it up (and you will) be willing to stop, adjust & make course corrections.

Mobile Devices Workflow Agility or Overload?

Mobile Fixed Moveable

Increased point-of-care

Technology Moves Incredibly Fast

• We all know about LAN’s

– Local Area Networks

• Within a particular building or on a small campus

• And WAN’s

– Wide Area Networks

• Across greater distances – cities, states, countries

• What about HAN’s?

– Human Area Networks

• The user, or their environment, is part of the computing process and facilitates data generation, capture, and analysis

Then Move To Technology & Innovation

– Consider the Following:

• Will the technology make the process produce

better outcomes, safer, faster, more efficient, or less

expensive?

– If the answers are all NO……STOP!

– Is this a Core Competency for IT?

» Why are you still in the cell phone business?

» Data Centers getting full? Perhaps outsource them.

» Security Monitoring is a really boring job!

Now That You Have Streamlined Your Operations…

– Consider the Following:

• Be the Business & Clinical Process Redesign Team your

Organization needs even if they don’t know it.

• Establish an “Innovation Garage” to evaluate new

technologies for the business.

– Be sure to include clinical & business users and leaders

– Staff it full time with repurposed team members from

outsourced areas

• The “Utility” runs fine (or it should), now you’re focused on

the Service Provider side of your house.

Now That You Have Streamlined Your Operations…(cont.)

– Consider the Following:

• Set a Goal to Abolish/Harness the 2 Other Types of IT!

– Shadow IT

– Rogue IT

OK, So I Have Done All Those Things – Now What?

– Look at the Business Goals & Objectives:

• Is the business expanding into Retail Health?

– Network-On-A-Cart

– Scripps Jumps In!

• Oh Yeah, How Does Your Own House Look?

– Get rid of the legacy stuff

– Customers want The Amazon Experience!

Data Or Information?

– Healthcare Produces A Lot Of Data!

• Data with context is information.

• Evaluate your Analytics Program:

– Start with governance – copy someone else’s if needed

– Don’t overthink it!

– Reduce the number of tools

• Now harness that information for the business……..

Use That Information!

– ~19% of Medicare Recipients Get Readmitted Within 30 Days

• This represents ~$26 billion in additional costs of which ~$17 billion is waste.

• CMS penalized 2,900 hospitals for readmissions.

• Use your analytics program to find those patients and make them actionable for your organization.

But Those Patients Aren’t Even In Our Facilities!

– Consider Partnering With Others

• ADT has 7 million homes in their customer base with over 100 million sensors online.

–What if they were used for glucose monitoring?

• A new CPT4 code provides $40 reimbursement per month for home monitoring.

–How can we leverage that?

– Is it even enough?

Finally…

– Innovate Based On Need & Benefit To The Patient

– Reduce The Legacy Footprint

– Outsource Non-value-added Functions

– Be A Passionate Business Partner

– Change No To Yes, But!

– You Likely Got Into Healthcare For The Mission – It’s OK To Remind Yourself Of That. Others Too!

Thank You!

Questions?

Kegley.Clark@ScrippsHealth.Org